Choosing wisely - recommendations from the RCGP

A helpful guide for those of us working in primary care as set out by the recent Choosing Wisely campaign. More info to be found at http://www.choosingwisely.co.uk 1. When patients are particularly frail or in their last year of life, unless there is a clear preference otherwise by the patient or advocate, discuss decreasing the number of medicines to only those used for control of symptoms. 2. Be alert to the possibility of dementia when an individual patient is seen rather than routinely screening whole groups of patients unless recommended to do so by the UKNSC. 3. If drug treatment is being considered to prevent heart disease, stroke or osteoporosis in previously well people ensure that this decision is shared with the individual concerned. 4. Only consider blood pressure treatment with drugs to prevent heart disease or stroke when the BP is consistently above 140-159/90-99 in people with additional risk factors. 5. If there is concern that a woman has polycystic ovaries, take a blood test to look for a typical hormone pattern before considering further imaging. 6. If an individual takes a statin at the recommended dose, there is no need to routinely check cholesterol levels unless there is evidence of pre-existing problems such as a heart attack, stroke or family tendency to have problems with lipids. I'm sure this is just the tip of the iceberg - does anyone else have a suggestion?